Karl Kurtz, Director of the Department of Health and Welfare, addressed the
Committee. He briefly discussed the divisions within the Department and
introduced Quane Kenyon, who is the chairman of the Health and Welfare
advisory board.

Scott Cunningham, Administrator of the Division of Welfare, addressed the
Committee. He explained that the Division of Welfare administers various
programs that serve individuals and families with low incomes and those in
crisis situations to help them become and remain self-reliant members of
Idaho communities. The programs administered by the Division are termed
the Self-Reliance Program. This program includes, child support collection,
Food Stamps, child care and cash assistance. Those who receive these
services are required to become employed and self-reliant. He stated that in
the past five fiscal years, applications processed increased by 58,000 cases,
or 60 percent. In that same period, the number of regional staff determining
eligibility declined.

He then explained the various programs administered by the Divison of
Welfare The first program discussed was the Temporary Assistance for
Families in Idaho program, (TAFI). It provides cash assistance to needy
families with children. The Department partners with families, community
programs, employers and other agencies to help participants obtain jobs and
achieve self-reliance. He stated that there is a 24 month lifetime limit for
adults to receive cash assistance.

Aid to the Aged, Blind and Disabled(AABD) provides cash assistance to
certain low-income participants who are blind, disabled or age 65 or older.
In state fiscal year 2002, a monthly average of 10,942 people received cash
payments under this program.

The Food Stamp Program helps low-income families maintain good health
and nutrition. This is a federally funded program managed by the State. Mr.
Cunningham explained that the benefits go directly from the federal
Government to the person. Approximately 58 million dollars in benefits were
paid in state fiscal year 2002.

The Idaho Child Care Program, (ICCP) subsidizes child care costs for low-income families while parents work or attend educational or training
programs.

Beginning in 1998, the Electronic Benefit Transfer(EBT) System was
implemented statewide to increase efficiency and reduce the cost of benefit
payments for the Self-Reliance Programs. Payments for Child Support,
Food Stamps, Temporary Assistance for Families in Idaho, and Aid to the
Aged, Blind and Disabled are made electronically.

The Department also provides a variety of Self Reliance programs. Adult
participants in the TAFI Program and certain adults in the Food Stamp
program are required to take part in these employment services to receive
benefits. The Department contracts with agencies and vendors to help
families search for, gain and keep employment. Mr. Cunningham stated
that these programs are also extended to non-custodial parents.

The Food Stamp Program includes the Job Search and Assistance
Program(JSAP) which was expanded throughout the state in 1998. The goal
of the program is to provide Food Stamp recipients with employment tools,
which they can use to become self-reliant. JSAP can help in job search and
referrals, unpaid work-experience opportunities, job skills training and
education. Approximately 5,900 food stamp recipients participate in the
JSAP program.

Adults participants who receive aid through TAFI are required to participate
in work preparation activities so they can become financially independent.
Approximately 65% of TAFI cases do not have work participation
requirements because they are “child only” cases. In these cases, adults do
not receive benefits.

The Child Support Program promotes physical and economic health of
families by ensuring parents are financially responsible for their chldren. The
program helps locate non-custodial parents and enforces their obligations
to provide financial and medical support for their children.

In 1999, the federal government mandated that all child support cases must
be administered by a single agency in each state. Health and Welfare was
chosen by the State Legislature to assume this responsibility. The
Department administered more than 92,000 child support cases, and
collected $140.3 million during state fiscal year 2002.

Child Support Services uses a variety of methods to enforce child support
orders. The primary tool for enforcing payments is Wage Withholding. Other
tools include New Hire Reporting through Electronic Date Matching, License
Suspension, and direct collection methods.

The Division of Welfare administers federal grant programs to improve living
conditions for low-income households and encourage self-reliance. These
programs include the following: Community Services Block Grant, the
Emergency Food Assistance Program, the Community Food and Nutrition
Program, the Low-Income Home Energy Assistance Program, the Telephone
Service Assistance Program, and the Weatherization Assistance program.

The Community Service Block Grant is distributed throughout all 44 counties
of Idaho by six Community Action Agencies and the Idaho Migrant Council.
The goals of the program are to revitalize low-income communities, reduce
poverty and empower families and individuals to become self-reliant.

The Emergency Food Assistance Program distributes USDA purchased
commodities through Community Action Agencies to help supplement the
diets of Idaho’s low-income population.

The Community Food and Nutrition Program provides education about food
distribution and nutrition through Community Action Agencies and the Idaho
Migrant Council to low-income people. The program helps coordinate
private and public food assistance programs to better serve low-income
populations. Funding comes through the Community Services Block Grant
and totaled $17,402 in State Fiscal year 2002.

The Low-Income Home Energy Assistance Program is federally funded and
helps Idaho’s low-income population pay a portion of their home heating
costs and provides energy conservation eduation through Community Action
Agencies. Payment is made to heating suppliers and vendors.

The Telephone Service Assistance Program provides assistance with
telephone installation and monthly service to low-income residents. Benefits
are provided by the telephone companies through charges included on their
customers’ phone bills. During State Fiscal year 2002, more than 32,000
households were served totaling $342,163.

The Weatherization Assistance program reimburses community action and
non-profit agencies that install energy conservation measures for low-income
people, particularly the elderly, disabled and families with small children. It
is a federally funded program and serves more than 1,400 households,
spending $1.8 million dollars in State Fiscal year 2002.

Mr. Cunningham then discussed with the Committee the faith-based
initiatives generated by President Bush. He explained that the goal of these
initiatives are to help more faith-based services to partner with the
Department of Human and Health services. He further explained that the
religious organizations must serve all individuals and federal funds cannot
be used for religious activities.

Mr. Dick Schultz, administrator of the Division of Health, addressed the
Committee. He explained that the Division of Health provides a variety of
services ranging from immunizations to food safety, and emergency medical
services to testing for communicable diseases.

The Division contracts with the District Health Departments to provide many
services throughout the state. Immunizations, epidemiology, sexually
transmitted diseases, food protection and oral health are all examples of
programs coordinated between State and local public health departments.

Mr. Schultz then discussed the various bureaus within the Division. They
include the following:

The Children’s Special Health Program contracts with clinics that are staffed
by physician specialists who diagnose and provide consultation for children
with special health care needs. The program also assists in paying, on a
sliding fee scale, for treatment of uninsured children. This program serves
approximately 2,400 children per year.

The Immunization Program provides around 500,000 doses of childhood
vaccine for all children in the state. The immunization rate at two years of
age is 75 percent and is 95 percent for school entry aged children.

The Newborn Screening/Genetics Clinic program provides physicians in the
state with access to laboratory analysis of blood samples collected on all
newborns for metabolic abnormalities. As there are no geneticists in the
state, the program contracts with geneticists from surrounding states. Mr.
Schultz stated that newborn screening has been paid for by the State in the
past and this has now been transferred to the parents.

The Reproductive Health program contracts with District Health Departments
to provide family planning services to women throughout the state. The
program serves approximately 30,000 women per year.

The STD and AIDS program also contracts with District Health Departments
to hold clinics for the diagnosis and treatment of people with sexually
transmitted diseases(STD’s) and their partners. The clinics also provide
diagnostic services for the HIV virus and the AIDS virus. If an HIV-positive
patient is under 300 percent of the poverty level, they may qualify for the
AIDS Drug Assistance Program.

The Women Infants and Children program(WIC) contracts with District
Health Departments and some tribes to provide clinical assessment of the
nutritional status of perganant or breastfeeding women and children under
the age of 5 years, who are below 185 percent of the poverty level If the
patient is found to be nutritionally compromised, prescription food checks,
(worth approximately $38 dollars per month) are provided for specific food
items to meet the nutritional risk.

About 33,000 patients per year are served by this program.

Mr. Schultz then discussed the various health promotion programs. These
programs include; the Adolescent Pregnancy Prevention program, the
Arthritis program, the Breast and Cervical Cancer Early Detection program,
the Diabetes Control program, the Injury Prevention program, the Oral
Health program, the Rape Prevention program and the Tobacco Prevention
program.

The Environmental Health Bureau includes the following programs; the
Environmental Health Education and Assessment program, the Food
Protection program, the Indoor Environment program and the Worker Health
and Safety program.

The Bureau of Health Policy and Vital Statistics include the Health
Surveillance and Statistics program which converts health data into
information. It is responsible for producing the annual vital statistics report
for Idaho, which contains all the information on births, death, and divorces
in the state. Other programs include the Public Health Preparedness
program, the Vital Records Management program and the Vital Records
Services program.

The Bureau of Emergency Medical Services was then discussed. The
programs include the Certification and Licensure program which is
responsible for the licensure of all EMS units in the state(approximately 200)
and the certification of all EMS personnel which number approximately 4,500
of which 68 percent are volunteers.

The Provider Resource program administers grants to primarily rural EMS
units to purchase ambulances and other needed equipment.

The Bureau of Public Health Laboratory includes the following sections;
chemistry, laboratory improvement, microbiology, and virology/serology.

The Division of Health also includes the Office of Epidemiology and the
Office of Rural Health and Primary Care.

During a question and answer period with the presenters, the following
points were discussed; Mr. Cunningham explained that the Food Stamp
program has increased from previous years and that outreach programs
have not been aggressively pursued by the Department. He further
explained costs of various programs and the funding for each. The TAFI

program was also discussed. Mr. Cunningham stated that because the
monthly grants are low, there is no incentive to remain on the program.
Recipients choose work over welfare.

In response to Committee questions, Mr. Schultz made the following
clarifications; the reason for the low immunization rate was discussed. He
stated that cost was not the barrier. He explained the challenge of
registering newborns on the state immunization system. 93 percent of those
babies born in hospitals enroll in the system. The rate is not as high for
those babies born outside of the hospital and those born in other states. He
also discussed how the Division of Health has dealt with the possibility of the
West Nile virus reaching Idaho.

He explained that the Division has crafted a plan with the mosquito
abatement districts for mosquito surveillance. He further explained that there
is currently a debate on how to effectively deal with the mosquito problem.

In response to questions from the Committee, Mr. Schultz discussed the
media ads for tobacco prevention and teen pregnancy. He stated that the
tobacco prevention ads were evaluated and found not to be as effective as
the current programs that encourage teen peers for prevention help and
cessation programs for older smokers.

Mr. Schultz also discussed the bioterroism threat. He explained that the
Division has evaluated a need for an additional 42 positions at the state
laboratory and is currently remodeling the lab to provide for containment in
handling contaminates.

Director Karl Kurtz address the Committee to summarize. He stated that
in the Department’s 2004 budget request, no more money will be asked for
Medicaid. They are asking for an additional $400,000 for individuals that the
courts have assigned to the Department for their care. He made the
following three points:

1. The Department will ask for 26 million dollars in General Fund monies; 17
million dollars of which will be for caseload increases for Medicaid.

2. The Department will ask for a 7 million dollar increase for Welfare
programs.

3. The Department will ask for a 3 million dollar increase for changes in the
federal medical assistance programs.

Chairman Sali thanked the participants and introduced those present. He
announced to Committee members that the Committee will meet at 8:30
A.M. on Friday, January 10th to hear an overview of the Division of Family
and Community Services and the Division of Medicaid. Providers will also be
present at the meeting to address the Committee.

Chairman Sali announced that the rules will be heard by the entire
committee and that review will begin next week. He further announced that
if any members of the Committee would like to cover a topic in more detail
and serve on a subcommittee to do so, should contact him as soon as
possible.

Joyce McRoberts, Deputy Director of the Department of Health and
Welfare, addressed the Committee. She explained that the Committee will
hear from two division administrators and followed by a question and answer
period. The Committee will then hear several short presentations from
various providers.

Ken Diebert, administrator of the Division of Family and Community
Services, addressed the Committee. He explained that the Division is
designated as the lead agency for the operation of the system of care for
adult and children’s mental health, adult and children’s developmental
disabilities services, infant and toddler program, substance abuse services,
and child welfare services with the Department of Health and Welfare. The
Division is also responsible for the operations of the State’s three state
hospitals. He further explained that these hospitals, which include State
Hospital South in Blackfoot, Idaho State School and Hospital in Nampa, and
State Hospital North in Orofino, are operating at or near capacity and have
waiting lists of up to ten days. These hospitals provide intensive residential
services for persons with severe developmental disabilities.

He then discussed with the Committee budget concerns. He stated that in
State Fiscal Year 2002, there was a 9 percent increase in the number of
individuals who accessed the Division’s services and programs from the
previous fiscal year. The current budget for Fiscal Year 2003 is about 11
million dollars less than the appropriation the Department received in the
Fiscal Year 2002. Staff have been reduced in all areas with the exception
of Child Protective Services.

Mr. Diebert explained that the Division has been faced with many difficult
decisions related to how best to manage the reductions in funding. As they
considered how to best manage the current resources, they based they
decisions on the following priorities:

They worked to avoid major impacts in the programs that the Department
has statutory responsibility to provide, they made every effort to avoid
staffing and service reductions that would impact community, staff and
consumer safety, and tried to be mindful of the need to provide federally
required maintenance of effort funding for their mental health, substance
abuse, and infant and toddler programs. Had they not maintained a federally
prescribed level of state participation in these programs they would have
risked losing significant amounts of federal funding.

He then described the various programs that fall under the Division of Family
and Community Services.

The first program discussed was the Idaho CareLine 211. This is a bilingual,
toll free telephone information and referral service. Last year, there were
over 38,000 calls for information about health and human service providers
in the State.

The Children and Family Services Program is responsible for Child
Protection services, Foster Care, Adoption, Children’s Mental Health, Indian
Child Welfare, and Licensing of Children’s Residential treatment facilities.

The Child Protective Services program focuses on safety, permanence and
the well-being of children. They work cooperatively with the police,
prosecutors and the courts to address the safety need of children who are
abused or neglected. In 2002, there were 783 substantiated cases of abuse
and neglect in Idaho. He clarified that the Child Protective service staff do
not remove children who are abused or neglected from their parents. A child
can only be removed from their parents by the action of law enforcement or
a judge once the child is determined to be in imminent danger or cannot be
safely cared for within their current family structure. When this determination
is made, the staff is then responsible for providing a safe and nurturing
environment for the child to live until they can safely be reunited with their
family, or in some cases, adopted by other caring families.

The cornerstone of the child welfare system is the Foster Care Program.
Foster families provide for a supportive temporary home for children placed
in state custody. 2,260 children were placed in foster care in the state last
year. In Fiscal Year 2002, 92 children were adopted in the state.

The Children’s Mental Health program provides services to children who
experience serious emotional disturbances. These services are provided
through a system of public and private partnerships that offer out-patient, in-
patient and residential care. The State has been working to develop a broad
spectrum of care to meet the needs of children and their families with serious
emotional disorders based upon a monitored agreement with the Federal
Courts.

The State entered into this agreement as a result of a suit filed against the
State known as the Jeff D. case. 3,766 children were assessed this past
year, which is 1,200 more than the previous year. The Department’s staff
provides crisis services, assessments, service authorization, provider
enrollment, training, and quality assurance. Approximately 85 percent of the
children who qualify for children’s mental health services are eligible for
Medicaid.

Other vital services provided by the Division come within the programs for
adults who are mentally ill. Services include crisis response, evaluation,
case management, treatment, psychiatric evaluations, medication
management and counseling. The Division also provides court-related
support services and placement coordination with hospital or residential care
as required. The majority of treatment services for Medicaid patients are
provided through a network of private providers. In State Fiscal year 2002,
over 6,000 individuals received services from the Division’s mental health
programs. This number reflects an 8 percent increase. The staffing in the
regional mental health programs has decreased by 23 staff. The Division
has accomplished cost saving by reducing administrative staff and shifting
some of the assessment function of the regional mental health authority to
private providers. They have fewer staff to respond to crisis calls, work with
courts, support resource development and to manage and evaluate program
effectiveness.

The substance abuse services program with the Division contracts out all
treatment services for their clients to private providers. Through
collaborative efforts with the courts, schools, Department of Correction,
Juvenile Corrections and the community, the system of care based on the
best practice models is being established in our state. In State Fiscal year
2002, 6,153 clients were served in this program. This is an 8 percent
increase from last year.

The substance abuse staff partnerships with the Idaho State Police for the
State’s Tobacco Project. This program is designed to reduce the sale of
tobacco to minors by education of merchants, retail permitting and
inspections. Since 1999, there has been a 12 percent drop in tobacco sales
to minors.

Mr. Diebert then discussed the group of programs that provide services to
people who are developmentally disabled. These programs are designed to
provide care and support of individuals and their families with developmental
disabilities. The programs are designed to provide services for everyone
from infants to the elderly.

The Idaho Infant Toddler Program serves children from birth to three years
of age. It coordinates early intervention and treatment services for children
and their families. The program partners with families to plan and provide
comprehensive services including speech, occupational, developmental,
medical and social work services to enhance each child’s developmental
potential. 2,424 children were served last year, which is a 4 percent increase
from the previous year.

The Division provides intake, eligibility, determination, service authorization,
provider enrollment, and training for providers for developmental disabilities
services. Of the adults receiving services through the Developmental
Disabilities Program this past year, 93 percent of them qualify for the
Medicaid program. 79 percent of the children and 63 percent of the
individuals served in the Infant and Toddler Program are eligible to receive
Medicaid funds. More than 11,857 people with developmental disabilities
received services funded by Medicaid than last year. State staff available to
administer these services have decreased by 17.

He then discussed the various core services that the Division provides or
contracts out and the key functions that must be in place to assure the
efficient operation of the various programs and services that the Division
manages.

He explained that the work performed by the Division is complex and
challenging. The individuals served have multiple and complex needs that
the Department strives to find effective interventions that will assist them in
developing life skills so they may function as independently as possible.

Kathleen Allyn, deputy administrator of the Division of Medicaid, addressed
the Committee. She explained that the Division of Medicaid administers the
state’s Medicaid program. This includes developing and implementing
program policy consistent with federal requirements, managing the quality
and utilization of services, and overseeing the payment process for services.
She further explained that there are several areas of overlap with the other
divisions within the Department that also provide Medicaid functions.

Within the Division of Medicaid, they also carry out the statutory state
licensing of health care facilities through the Bureau of Facility Standards.
This includes inspections of any state-licensed facility, whether or not it
cares for Medicaid clients, as well as investigations of complaints about the
facilities.

She then explained the difference between the Medicare program and the
Medicaid program. Medicare is also known as Title XVIII and is a federal
program that serves the elderly. Medicaid is a state program also known as
Title XIX which serves low income clients.

Medicare was established to cover the specific medical care needs of the
elderly and is available to most people over age 65 regardless of income.

Medicaid is the nation’s health insurance program for many low-income
Americans. Medicaid is a jointly-funded federal/state entitlement program,
administered by the states, that pays for medical assistance for certain
individuals and families with low incomes and resources.

In Medicaid, each state, within federal guidelines, establishes eligibility
standards; determines the type, amount, duration, and scope of services;
sets the rate of payment for services; and administers the state’s program.

Idaho has a basic program. There is currently on average, about 150,000
people on Medicaid, which includes about 105,000 children. The state has
chosen not to cover all of the groups or services that would be matched by
federal dollars. Idaho is projected to spend about $849 million on Medicaid
in State Fiscal year 2003, about $234 million of that in State General Funds.

Most people who use Medicaid can’t afford private insurance or need
services that are not available from private insurers such as services for
persons with developmental disabilities or traumatic brain injury.

The Department provides few direct healthcare services. Through Medicaid,
they support the existing health care structure. Idaho Medicaid pays more
in benefits in Idaho than Blue Cross and Blue Shield combined.

Because of the escalating costs of the program, Medicaid has intensified its
focus on the development of quality improvement processes and care
management tools that can create a healthier public and result in a more
efficient use of tax dollars.

Those eligible for Medicaid fall into three low income groups. These include
parents and children, the elderly and persons with disabilities.

Ms. Allyn explained that pregnant women and children in families with
incomes below 134 percent of the federal poverty limit must be covered by
Medicaid.

Medicaid primarily covers hospital and physician care of the elderly. It does
not cover most nursing home or other long term care costs or most
outpatient prescription drugs. But Medicaid pays for these and other
services not covered by Medicare when someone is covered by both
Medicare and Medicaid.

Many elderly people must be covered by Medicaid because they receive
cash assistance through the Supplemental Security Income (SSI) program.
Others have too much income to qualify for SSI but “spend down” to
mandatory Medicaid eligibility by incurring high medical or long-term
expenses.

Many people with disabilities also must be covered by Medicaid because
they receive cash assistance through the SSI program or because they incur
large medical expenses and meet their “spend down” obligation.

She further explained that it is not enough just to be poor to qualify for
Medicaid; an individual must also fit into a covered eligibility category. Many
people with low incomes, including childless couples and single, childless
adults who are not aged or disabled cannot receive Medicaid even though
they are poor.

Additionally, in 1997, Congress enacted Title XXI of the Social Security Act
which allowed states to provide health insurance for children in families with
incomes over the Medicaid eligibility level. This is the State Children’s
Health Insurance Program or S-CHIP. Rather than developing a separate
insurance program for CHIP kids, Idaho insures them through the Medicaid
program. Children from families with household incomes from 134 percent
to 150 percent of the federal poverty limit qualify for S-CHIP. At the end of
State Fiscal year 2002, there were over 12,000 children enrolled in S-CHIP.

By choosing to participate in Medicaid, Idaho must cover a minimum set of
benefits. These federally mandated benefits include: hospital care(inpatient
and outpatient), nursing home care, physician services, laboratory and x-ray
services, early and periodic screening, diagnostic, and treatment services for
children, family planning services, and federally qualified health center and
rural health clinic services. Idaho has also chosen the option of covering
additional services and receiving federal matching funds for those services.
These optional services include; prescription drugs, institutional care for
individuals with mental retardation, home and community based care for the
frail elderly and people with physical or developmental disabilities, personal
care services, services for people with developmental disabilities, mental
health services, and adult dental care.

Medicaid pays medical care providers directly for services provided to
Medicaid clients. Providers participating in Medicaid must accept Medicaid
payment rates as payment in full.

The Federal Government pays a share of the medical assistance
expenditures under each State’s Medicaid program. Idaho receives about
a 70 percent federal, 30 percent state match. For S-CHIP the federal match
rate is higher, with 80 percent of the program paid for with federal dollars and
20 percent with state general funds.

Ms. Allyn explained that federal legislative requirements have increased the
scope of the program to the point that about 45 percent of the Idaho
Medicaid budget goes toward meeting federal mandates. She further
explained that approximately 43 percent of the Idaho Medicaid budget is
governed by state law. In all, 88 percent of the Idaho Medicaid budget is
driven by either federal or state law.

Ms. Allyn then discussed with the Committee managing the cost of
Medicaid. She explained that because Medicaid is an entitlement program,
the state is required to pay for all medically necessary covered services that
are provided to persons enrolled in the program. The Department has seen
four budget cuts since 2001. In Medicaid alone, this has meant $115 million
in cost avoidance.

The Medicaid program is now undertaking more intensive review of
programs and services primarily focused on the high cost areas of the
program. The top six spending areas in the program are hospitals, nursing
facilities, prescription drugs, developmental disability services, physician
services and mental health services.

Ms. Allyn stated that Medicaid is working to increase enrollment in the
Healthy Connections program which links Medicaid clients with primary care
providers who manage their care. Through this program, Medicaid avoids
spending about $31 per month for each Healthy Connections enrollee.

She further stated that management steps are being developed for the
prescription drug program that could reduce the Medicaid pharmacy budget
by $42 million. These steps include denying early refill of prescriptions,
requiring prior approval of certain therapeutic drug classes, reviewing high
prescription volume clients, and the implementation of a preferred drug list.

Also, the Medicaid program has developed lower cost alternatives to
institutional care such as nursing home care or intermediate care facilities
for persons with mental retardation. Known as home and community based
waivers(HCBS), these programs allow eligible elderly and disabled
individuals to receive the services they need without having to be placed in
an institution. The costs for supplying the waiver services must be no
greater than the cost of the institution.

She explained that the Aged and Disabled Waiver or A&D Waiver is the most
widely implemented waiver in the state with an average of 3,600 enrollees.
The average annual cost of someone on the A&D Waiver is $13,000 per
year compared with the nursing home average annual cost of $38,000.

In summary, Ms. Allyn, explained that the economic predictions for fiscal
year 2004 show the need to maintain the current reductions and find more
ways of managing costs. But, unless the current projected revenues
increase, the state may also need to make significant reductions in the
people or services that are covered or the amount that is paid for services.

In response to questions from the Committee, the following points were
clarified by Mr. Diebert; the prevention programs for tobacco prevention is
focused on school-aged children and tobacco sales to minors are tracked
with a partnership program with the Idaho State Police. The reasons why the
Sate hospital is overcrowded was also discussed. Mr. Diebert explained
that in addition to population growth, there has been a decrease in bed
capacity in the past ten years. There is a decrease in staff and a significant
decline in federal and state funding.

In response to questions posed by Committee members, Gary Broker, from
the Department of Health and Welfare, addressed the Committee. He
discussed the overall funding of the Department and the overlapping of
services provided.

Also in response to questions from Committee members, Dr. Tom Young,
medical director for the Division of Medicaid, addressed the Committee. He
discussed rising prescription drug costs. He explained that Medicaid is
going to an evidence-based preferred drug list, which will bring substantial
savings to the program. It will provide guidelines to physicians of various
prescription drugs that can be used by patients.

Kathleen Allyn discussed the eligibility determinations for the Medicaid
program with the Committee. She also discussed the fraud and abuse unit
which investigates both provider and clients.

Randy May, an administrator from the Division of Medicaid, spoke to the
Committee in response to questions. He discussed the eligibility of children
enrolled in the States’ CHIP program. He stated that 98 percent of CHIP
kids are eligible.

Rick Sutton, a pharmacist for 30 years, addressed the Committee. He
discussed the preferred drug list. He explained that it is scientifically based.
A profile is submitted to a scientific body and evaluated on specific criteria,
then evaluated by a panel of physicians and pharmacists and a
determination is made. He further explained that Medicaid will pay for a
product on the preferred drug list.

Dr. Ted Epperly, a family physician and chairman of the Family Practice
Residency Program, discussed the residency program the Committee. He
explained the program takes nine residents from other states and trains them
in family practice medicine. He explained that the residency program has
impacted the state’s Medicaid program in the following areas, education,
practicing physicians, and physician care. He further stated that the
residency program is tremendously underfunded and it is a challenge for the
state to make it work. He further stated that because of low Medicaid
reimbursement rates, many physicians choose not to treat Medicaid patients.
Most physicians treat zero to five percent Medicaid patients. He said that
every citizen has the right to quality health care and citizens must be willing
to pay more taxes to fund needed programs.

Jon Ball, an administrator and provider of Residential Habilitation services,
addressed the Committee. He discussed what a provider has to do to qualify
to be a provider for the state. He stated that he has received a 70 percent
reduction in his wages from the state. He further stated that a client in a
residential habilitation home is treated as a family member; and the facility
has an excellent ratio of care with providers to clients.

Bill Benkula, an administrator of intermediate care facilities for the mentally
retarded and facilities for the those with developmental disabilities,
addressed the Committee. He explained that ICFs/MR form a long term
care and training delivery system for individuals with mental retardation and
or developmental disabilities. These facilities provide a wide variety of
services based on client needs, which vary according to age and level of
mental retardation. In addition to providing a home like environment with
personal and support services, ICFs/MR serve as teaching and training
facilities. Many individuals who reside in these facilities live there from youth
to old age.

ICFs/MR vary from facility to facility and state to state, but are all bound by
federal regulations. A common goal among facilities is to assess what
individuals are capable of doing and to help them maximize their potential.

Mr. Benkula discussed the levels of mental retardation which include; mild
(IQ of 50-70), moderate(IQ of 35-49), severe(IQ or 20-34) and profound(IQ
below 20).

He then discussed the federal guidelines that define mental retardation as
significant subaverage general intellectual functioning resulting in or
associated with concurrent impairments in adaptive behavior and manifested
during the developmental period.

He further stated that the trend in caring for these individuals over the past
20 years has been marked by a dramatic shift from large state-run
institutions to smaller, privately run facilities. The population of the Idaho
State School and Hospital has dropped from 1,200 down to approximately
100 patients today. Home and community based (HCB) waivers are also
growing.

He stated that individuals admitted to ICFs/MR must be receiving active
treatment services. Within 30 days following admission, an assessment is
made from facility interdisciplinary teams.

He further stated that because adults with developmental disabilities require
lifelong support, these adults are highly dependent on public programs to
finance their long term care needs.

Mr. Benkula also discussed with the Committee the Developmental
Disabilities Agencies(DDA’s) He explained that these agencies provide
rehabilitative and habilitative services to individuals diagnosed has having
a developmental disability. Services are provided in community based
settings in natural environments such as home, work, leisure, or center-based settings. Services provided by DDA’s promote independence,
participation and inclusion of people with developmental disabilities in their
neighborhoods and communities.

DDA’s are required to provide the following services; developmental therapy,
psychotherapy, speech and hearing therapy, physical therapy, occupational
therapy and evaluation and diagnostic services.

Kathy Gneiting, chairman of the Community Integration Committee, and
mother of an 8 year old son with autism, addressed the Committee. She
explained that the Committee first met in September of 2000. The CIC
makes recommendations to the Governor. The purpose of the committee is
to integrate people with disabilities in the community, school and workplace.
The four objectives of the committee are, to launch an anti-stigma campaign,
a state-wide assessment program, economic analysis and an effectiveness
study.

Marilyn Sword, representing the Idaho Council of Developmental
Disabilities, addressed the Committee. She explained that the board
consists of 23 members who are appointed by the Governor for a three year
term. The board are policy advocates and collaborate with other agencies.

Greg Dickerson, president of the Mental Health Providers Association of
Idaho, addressed the Committee. The goals of his association include the
avoidance of the high cost of institutional care and the avoidance of
homelessness. There is a full menu of services available. He explained that
Targeted case managers are available to help clients cut through the
government red tape and get the services they need.

Ida May Whitman, immediate past chairman of the Mental Health Planning
Council, spoke to the Committee. She stated that the council meets three
times a year and reports to the Governor on the mental health needs in the
state. She further stated that there are approximately 43 members on the
council. There are three standing committees which include the children’s
mental health committee, administrative education committee, and a
committee to monitor and check statistics. She explained that the council is
in favor of having the “Jeff D.” lawsuit stay on the books.

Bill Southerland, president of the Idaho Assisted Living Association,
addressed the Committee. He explained that Assisted Living provides
assistance, where needed, to the Aged and Disabled population in a
dignified community setting. Persons who are not comfortable living alone
because of physical, mental or developmental limitations may receive the
personalized help they need to live as independently as possible.
Assistance offered includes, but is not limited to, housekeeping services,
transportation, bathing, grooming, dressing, toileting, walking, meal
preparation, access to health and medical services, 24-hour security, 24-hour staff availability, in-room emergency call systems, health promotion,
exercise programs, medication management, personal laundry services, and
social and recreational activities. He stated that there are 260 facilities in the
state and that most are in the 8 to 15 bed capacity range. He further stated
that the Aged and Disabled waiver patients, under strict federal guidelines,
can access certain Medicaid services to specific populations with slightly
above-normal restrictions. The Federal government sees waivered
programs as a long term savings so they provide an attractive match.

Keith Holloway, a nursing home provider, addressed the Committee. He
explained that nursing homes provide care for the most frail of the elderly.
There are approximately 85 nursing homes in the state, 30 of which are in
small rural towns and often the town’s largest employer. He further
explained that with the growth of waivered programs, the number of patients
in nursing homes has decreased in the last five years.

Steve Millard, president of the Idaho Hospital Association, addressed the
Committee. He explained that there are 46 public hospitals in the state and
18 are critical access hospitals. 50 to 60 percent of hospital patients are
Medicare patients, and 10 to 15 percent are on Medicaid. 30 to 35 percent
are privately insured.

Chairman Sali thanked the presenters and asked Committee members to
contact any of today’s speakers on their own if they had any questions. He
announced that the Committee will start rules review the following week.

Karen Gustafson, assistant administrative rules coordinator for the
Department of Administration, addressed the Committee and gave a brief
explanation to Committee members of how docket numbers are assigned,
the different types of rules, and the actions that the Committee members can
take on the rules.

She explained that every agency is assigned a two digit number, which is the
first two numbers of each docket. The next four numbers of the docket refer
to a specific division, and the last numbers refer to when the rule was
published.

She then described the three kinds of rules. These include; pending rules,
which are published by the agencies during the calendar year 2002 and are
submitted for legislative review. Pending rules will go into effect unless the
Committee takes negative action. Both Houses have to agree to reject a
pending rule.

The pending fee rules are published during the calendar year 2002 that
impose a fee or charge. They also have to be rejected by both Houses.

Temporary rules are ones that are approved by the Governor that went into
effect during calendar year 2002 without legislative review. These rules will
die at the end of the session unless they are extended by the Legislature.

Rayola Jacobsen, bureau chief of Occupational Licensing, addressed the
Committee. She gave a brief overview of the Bureau. She explained that
the Bureau of Occupational Licensing was established in 1974 and serves
18 different boards.

The Bureau administrates, investigates, and provides legal representation
for those boards. It is funded by dedicated funds and use no State General
funds. She further explained that there are 17 staff which include five
investigators. The Bureau oversees over 20,000 licensees. She further
explained that the Bureau has several hearing officers to hear cases.

The Committee did not find any basis to reject Docket 19-0101-0201.

Sarah Scott, from the Office on Aging, presented the following dockets
to the Committee. She explained that the Office provides services to
adults 60 years of age and over. There are no income requirements and
more than 50 percent of the funding is federal. There are six planning
and service areas in the state and there are 18 staff.

The Committee did not find any basis to reject Docket 15-0101-0201.

The Committee did not find any basis to reject Docket 15-0102-0201.

The Committee did not find any basis to reject Docket 15-0121-0201.

This Docket is a pending fee rule. Ms. Evans explained that this rule is
necessary to implement provision of House Bill 393 passed by the
Legislature last session and which became effective on July 1, 2002. HB
393 established an emeritus status license for nurses who have retired
from active practice, but who wish to continue to use the protected titles of
licensed practical nurse, registered nurse, certified nurse midwife, clinical
nurse specialist, nurse practitioner and registered nurse anesthetist.

The rule provides for the following; established the process for the
biennial mailing of renewal notices and applications for LPNs and Rns
who hold emeritus status licenses; differentiates the process for
application to reinstate to unrestricted status a license disciplined by the
Board from an emeritus license; establishes requirements for
reinstatement of an emeritus license to unrestricted status; and
establishes a fee of $25.00 for initial application for the emeritus license, a
fee of $20.00 for biennial renewal of the license, and a fee of $35.00 for
late renewal or reinstatement of a lapsed emeritus license.

After Committee discussion the Committee did not find any basis to reject
Docket 23-0101-0201.

The rule consolidates and renumbers existing rules. They provide
clarification and structure to defined scopes of practice for RNs and LPNs.
The delete language detailed listings of nursing functions for each
category of licensure, replacing them with a standard for decision making
within each respective scope of practice. They clarify parameters for and
responsibilities when delegating nursing functions to unlicenced assistive
personnel.

Ms. Evans explained that in general, this rule is a revision of existing
rules defining the practice of licensed professional nurses, licensed
practical nurses and unlicenced assistive nursing personnel.

They do not represent a change in defined scope of practice, but instead
serve to clarify the currently defined scopes for these licensees.

In addition, they modify, add and delete definitions for terms used
throughout the Board’s rules. Finally, they allow for administration of
training programs for nursing assistants in education institutions
accredited by organizations recognized by the U. S. Department of
Education.

In discussing this rule, Vice-Chairman Block put the Committee at ease.

Vice-Chairman Block called the meeting to order at 3:25. After
Committee discussion, the Committee did not find any basis to reject
Docket 23-0101-0202.

This is a fee rule that sets out specific criteria for ephedrine products that
can be sold without a prescription. These criteria include maximum
dosage requirements and label disclosures and warnings. Mr. Markuson
explained that the fee being imposed is justified and necessary to avoid
immediate danger. He further explained that an immediate danger is
inherent in ephedrine products if they are sold in dosage amounts in
excess of the rule or containing synthetic rather than naturally occurring
ephedrine alkaloids. He stated that the fee charge under this rule is
necessary to ensure compliance with the requirements of the rule. This is
a temporary rule that is now in effect and is similar to rules on other
states. The $1,000 registration fee is charged to manufacturers and
wholesalers who must register with the Board of Pharmacy and that fee is
good for one year. Registration is renewed each year for $1,000. Mr.
Markuson explained to the Committee that a yearly registration fee has
always been charged to wholesalers and retailers. The $1,000 fee would
help the Board keep close tabs on the product.

Lengthy Committee discussion followed, with the following point clarified
by Mr. Markuson; ephedrine is a prescription drug, but there are over the
counter drugs that contain ephedrine and that is what this rule is referring
to.

Chairman Sali stated that he wanted to get more information before the
Committee took action on the Docket.

The Committee did not find any basis to reject Docket 27-0101-0202.

The Committee did not find any basis to reject Docket 27-0101-0203.

The Committee did not find any basis to reject Docket 27-0101-0204.

The Committee did not find any basis to reject Docket 27-0101-0205.

Vice-Chairman Block put the Committee at ease.

Vice-Chairman Block call the meeting to order at 5:20 P.M.

After Committee discussion, Chairman Sali made a Unanimous
Consent Request to have the minutes reflect the official committee
action after each rule docket as the following; The Committee did not find
any basis to reject the Docket. Rule Docket 27-0101-0201 was excepted
from the request. There were no objections.

The Committee did not find any basis to reject Docket 16-0309-0206.

In addition, the Department was considered to be the Common Law
employer of such individuals, creating a potential liability risk.

All other independent providers have been required to be employees of an
agency for some time. This rule change treats all providers of similar
services consistently by the Department. These rules also clarify that
RESHAB providers who provide services in their own homes as Certified
Family Homes must be affiliated with a RESHAB Agency for training and
oversight.

The Committee found no basis to reject Docket 16-0309-0207.

The Committee found no basis to reject Docket 16-0309-0208.

The Committee found no basis to reject Docket 16-0309-0210.

The Committee found no basis to reject Docket 16-0310-0201.

First; eliminating the cash flow problem experienced by small ICF/MR
facilities when a participant requires a highly specialized and expensive
wheelchair, as the Medicaid program pays for such chairs on a fee schedule
rather than billed charges; second, the cost is less to the Medicaid program,
and third, the participant is more readily accepted for admission into the
small facilities and keeps the wheelchair, no matter if he moves between
facilities or into a community placement.

The Committee found no basis to reject Docket 16-0310-0204.

The Committee found no basis to reject Docket 16-0310-0301.

The Committee found no basis to reject Docket 16-0309-0212.

Terri Sterling, a member of the Idaho Community Action Network(ICAN),
addressed the Committee. She testified against this docket. She stated that
because of this rule change, 37,000 people were cut off for adult dental care.
She further stated that it is good for the State’s economy to invest in
Medicaid. She related a personal experience that she could not find a
dentist in northern Idaho who will take Medicaid patients due to the low
reimbursement rates.

Committee discussion followed with the following points covered; new rules
would have to be promulgated if this docket is rejected, and new legislation
would have to be drafted to amend the legislative intent language in the FY
2003 appropriation bill. Also funding for up to $7 million would have to be
found for FY 2003 and $8.4 million for FY 2004.

The Committee found no basis to reject Docket 16-0309-0301.

The Committee found no basis to reject Docket 16-0311-0101.

EXCUSED:

Ms. Gustafson also further clarified the action that the Committee can take
on rule dockets. She explained that pending rules will go into effect unless
negative action is taken. The Chairman of the Committee sends a letter to
the Speaker of the House indicating which rule dockets the Committee has
rejected. She further explained based on an opinion from the Attorney
General’s Office, that the Legislature cannot amend or modify the rules.

The Committee can reject an entire rule, section or subsection.

She also discussed negotiated rule-making. She explained that this is not
mandatory process. Negotiated rule-making brings all of the players to the
table before the rules are published and the meetings do not have to meet
the open public meeting law. It is an informal process, and tries to bring
consensus before the rule is drafted.

The Committee found no basis upon which to reject Docket 16-0205-0201

Definitions are clarified and the five conditions detectable by newborn
screening were added to the reportable disease list, as were three
infectious diseases. The reporting period was shortened from seven days
to three days. Mr. Schultz discussed section 23 of the rule that relates to
isolation. The rule adds that “persons who may have been exposed to a
highly contagious infectious agent” may be isolated. He explained that
this is an attempt to limit the spread of the disease and each individual
reacts differently to exposure.

The Committee found no basis upon which to reject Docket 16-0210-0201.

The rules are changed to be consistent with the new professional titles. He
explained that providers and consumers will notice a name change but no
other substantive change in the new rule. He further stated that the
Department will incur a cost of about $280 for publication.

For mentally ill individuals, crisis hours are contained in the new four hours
per month limitation. As of December 2002, there were 64 providers actively
providing mental health case management services to 1,800 Medicaid
recipients. In fiscal year 2002, Medicaid spent approximately $6 million for
this service. Negotiated rule-making was not conducted because rule-making occurred to comply with executive mandate and because of the need
to implement the reductions to achieve projected savings.

EXCUSED:

The first objective of the subcommittee is to further consider the rejection of
rule Docket 16-0309-0216. The subcommittee will present their
recommendations to the full Health and Welfare Committee.

The Committee cannot take any action by itself. JFAC has the authority to
restore funds to the adult dental program.

The second objective of the subcommittee is to address legislation that
amends the intent language of the Budget Appropriation Bill(SB 1490).

The language that would be stricken in Docket 16-0309-0216 is found on
page 83, section 900, sub section b, and the language on page 84,
subsection (05).

Kathleen Allyn, deputy administrator for the Division of Medicaid, spoke to
the Committee. In response to questions from Committee members, she
discussed various cost-saving methods within the Department of Health and
Welfare. One of these discussed was the refunding of unused prescriptions
in assisted living facilities. This could result in a one million dollar savings
in general fund monies. Low participation from these facilities is a concern,
and the need for an incentive to participate was discussed. Other
suggestions from Ms. Allyn included; more management of Developmental
Disability programs, and reductions in other kinds of services,
reimbursements, and eligibilities. She explained that the 30 percent cuts are
not across the board and the programs within the Department have not been
built as a whole. She further explained that there are about 25 different
eligibility categories and it is difficult to try to reduce in this area. She stated
that the Department is $200,000 in the black for the current fiscal year out
of an $800 million budget.

In response to questions from the Committee, Jim Baugh, executive director
of Co-Ad, Inc., disability advocacy services, addressed the Committee. He
explained that illegal aliens are not entitled to Medicaid services.

Ms. Allyn further discussed the idea of refunding unused prescriptions. She
stated that this could be implemented by July 1st or earlier, but not in time
to help with the additional funding for 2003. She further stated that currently,
nursing homes are the only facilities who return unused prescriptions. The
Committee discussed other facilities who could participate including
correctional facilities.

Chairman Block asked that the members of the subcommittee decide what
area they would like to work on which include; working on draft language to
amend the intent language of the Appropriation bill, and researching ways
to come up with funding alternatives.

Jim Baugh offered to Committee members a copy of a report outlining the
economic impacts of Medicaid. The report discusses how jobs and the
economy are affected by cuts in the Medicaid program.

Chairman Block told Committee members that she would let them know the
date of the next meeting.

EXCUSED:

The Committee found no basis upon which to reject Docket 16-0309-0204.

The Committee found no basis upon which to reject Docket 16-0314-0201.

The Governor directed state agencies to reduce State General Fund
expenditures by 3.5 percent. The 3.5 percent reduction in hospital
reimbursement, as reflected in these rules, is anticipated to save
approximately $2.5 million in Medicaid’s state fiscal year 2003 budget. She
further explained that all individual hospitals received prior notice of the
reduction in their interim payments and the related change that will occur
during the cost settlement process. The following changes were outlined;
the percentage will be 96.5 percent of covered charges rather than 100
percent; all hospitals will be affected by this reimbursement reduction; re-basing occurs prior to setting the new interim rates; and the reimbursement
floor percentage will be 81.5 percent rather than 85 percent. In addition,
hospital representatives and Medicaid staff are exploring the feasibility of a
prospective payment system in order to enhance planning, minimize
payment delays, and ensure that Medicaid has the right price for the right
care.

They carefully review each case to ensure compliance by the counties and
the applicants. The CAT board does not spend any money other than
what is required by statute. Whenever possible, they return surplus funds
to the general account. In Fiscal Year 2000, the CAT fund returned over
$4 million. The Board operates without any reserves. The majority of
those served by this program are single member families. Mr. Hall further
explained that for tobacco-related incidents counties can use funds from
the millennium fund money and then only pay the first $5,000 instead of
$10,000.

It also lengthens Food Stamp eligibility for some households in high
unemployment areas beyond the three-month limit if complying with the
work plan.

The number of new brand name drugs and classes of drugs that
continuously become available make it impossible to continue listing each
specific drug in rule. These temporary rules allow Medicaid to review
brand name prescription drugs for medical necessity and determine when
there may be a less expensive and equally effective drug available. These
rules describe when a prescription is considered medically necessary and
clarify coverage and limitations. Additionally, by identifying categories of
drugs that must be prior authorized rather than identifying each specific
drug, the Department does not need to update rules every time a new drug
is introduced by the pharmaceutical industry. Further, under the existing
rules, early refill of prescription drugs has been identified an unnecessary
and costly practice that needs to be controlled to reduce unnecessary
Medicaid spending. These temporary rules allow Medicaid to require that
75% of the estimated-days supply of prescription medication have been
used before Medicaid will pay for a refill. Medicaid identified three
therapeutic drug classes, including prescription antihistamines, antacids,
and antidepressants. Finally, she explained that without these rules, the
Department’s ability to manage pharmaceutical costs will be severely
restricted.

Mr Roden raised the following issues regarding the rule:1. He questioned
whether the department has authority to implement a preferred drug list; 2.
He stated there were no appeal rights in this rule if a request for prior
authorization request was denied; 3. He questioned whether the drug
rebates were be accounted for properly as non-cognizable funds; 4. He
stated that the definition of “medically necessary” should not include the
concepts of “more conservative or substantially less costly”. He stated he
did not understand what those terms meant in that context; 5. He stated
that the process for a preferred drug list is not adequately spelled out in
the rule docket; 6. He stated that the the requirement in paragraph
821.03.v that a prescribed medication must be the least costly is confusing
because a doctor would not know the exact costs for a medicine at the
time he prescribed it. He also stated that while most physicians
understood what generic interchange is, therapeutic interchange was not
defined in the rule and is not a standardized concept that physicians would
understand. Mr. Roden also explained that the process for this docket has
not been transparent and that there is nothing in this rule that requires it to
be transparent. He stated that this issue needs to be discussed in an open
manner, with all interested parties participating in that discussion. He also
discussed the rebates that are paid to the State for pharmaceuticals. He
further discussed the extensive paperwork that is involved with prior
authorization.

EXCUSED:

EXCUSED:

Docket 16-0601-0201:

He explained that this rule change provides the Department with the ability
to refuse to renew a retailer’s tobacco sales permit when the retailer has
unpaid civil money penalties for violations on the permit. A permit would be
issued when the penalty paid in full. This rule also adjusts the date used to
determine the number of permits from January 1 of each year to December
31 of the previous year.

In response to questions from Committee members, Ms. Heady explained
that the Council operates on a shoestring budget with only three staff
members. Also in response to questions, she explained that the number of
domestic abuse cases are difficult to track, but seem to be staying at the
same level for several years.

EXCUSED:

She explained that the purpose of the meeting is to consider the rejection of
Rule Docket 16-0309-0216 and to make a recommendation to the full
Committee. She further explained that an opinion from the Attorney
General’s office states that Idaho Code overrides the intent language of the
2002 appropriation bill concerning coverage of emergency adult dental
services.

After Committee discussion, Rep. Nielsen amended his AMENDED
SUBSTITUTE MOTION. His motion was to recommend to the full
Committee to accept Docket 16-0309-0216 and to direct the Department of
Health and Welfare to provide adult dental care for fiscal year 2004 for the
high-risk population and to provide adequate reimbursements to providers.

EXCUSED:

The registration fee will be changed from $1,000 to $100 in the new
temporary rule, and that fee will be charged to the manufacturers,
wholesalers or other entity which first produces or brings the product in
Idaho.

Once developed, the Department would have the responsibility for submitting
the waiver for approval. Once approved, the waiver would be demonstrated
for a period of at least two years, allowing participants adequate opportunity
to determine its usefulness and allowing the state the time needed to
analyze its cost effectiveness. Ms. Sword further explained that other states
have this model in effect and by having this in a resolution from the
Legislature, it would increase the likelihood for this project going forward.
She also discussed the fiscal impact and possible changes. The Committee
asked that the cost for training be further clarified.

The Defendants named in the suit included the Governor of Idaho, the
Director of the Department of Health and Welfare, the Clinical Director and
Administrator of State Hospital South and the State Department of
Education.

EXCUSED:

These concerns include; whether the Department has the authority to
implement prior authorization and other care management measures, the
term “therapeutically interchangeable” is not defined in the rules, the rules
do not specifically provide for emergency refills, the rules do no specify a
turnaround time for prior authorizations, the client appeal rights are not
specified in the rule, and the definition of “medical necessity” included the
phrase “substantially less costly”. She further stated that the Department will
listen to public comments and can amend the temporary rule.

EXCUSED:

EXCUSED:

Rep. McGeachin explained that the number of dollars that the Department
of Health and Welfare has claimed to have saved in reduction of personnel
cannot be substantiated by the Department of Human Resources. She
further explained that it appears that the average salary in Medicaid is higher
than the average salary in the other divisions, and that overall administrative
costs could be reduced to be more in line with the other divisions. Lastly,
she explained that she recommends that the appropriation for vehicles
should not be approved until the Department has increased the average
mileage of vehicle use as recommended by the Office of Performance
Evaluations, and has reached the recommended 75,000 to 100,000 miles for
vehicle disposal.

EXCUSED:

In response to questions from Committee members, he explained that the
Division of Welfare has been designated to be the state’s agency for the
receiving and the collection of child support payments. He stated that
between $140 million and $150 million is collected per year in child support.
Also in response to questions, Director Kurtz stated that the Department
would welcome the ability to return unused medications and will visit with the
Board of Pharmacy for possible implementation. In response to questions,
he also explained that the Department has received about 20 responses
from employees giving ideas for cost-savings within the Department. He
stated that these ideas have been forwarded to the Joint Finance and
Appropriation Committee, and employees have been encouraged to share
ideas.

EXCUSED:

She further explained that this will help reduce costs of healthcare,
especially as it relates to prescription medications for the elderly and
disabled. She stated that $3 to $4 million in medications are destroyed each
year, about $1.7 to $2 million in Medicaid. She further stated that this
resolution would allow providers, the Idaho Board of Pharmacy and the
Health and Welfare Bureau of Facility Standards to work together to develop
simple, enforceable changes to regulations to allow drugs distributed in
blister packs to be returned to pharmacies. It would also provide adequate
compensation to pharmacies accepting unused blister packaged drugs and
with private payers, allow consumer demand to control the amount of drugs
being returned and reused. Ms. Glasgow clarified that consumers will be
able to choose a pharmacy that would allow returns and the dispensing
pharmacist would have the final say if the medication is returned. She
further clarified that Assisted Living Facilities are currently required to
destroy medications every 30 days.

He spoke of his personal experience with his brother who is developmentally
disabled. He pointed out that the cost-savings in region II with the pilot
program were no different than the savings in Region IV without the pilot.

EXCUSED:

She stated that this legislation supports the efforts to remove discrimination
of those with mental illness or disability and focuses on the relationship of
the parent and child.

The Department of Health and Welfare estimates that there are
approximately 1,000 women who would qualify for this benefit. Rep.
Henbest explained that there would be no negative fiscal impact because
for every dollar the state spends on prenatal care, delivery services and post
partum care, the state will save two dollars in neonatal intensive care costs.

EXCUSED:

He further explained that there is only one way to become an athletic trainer
and that the internship program will no longer exist after this year. A
baccalaureate degree is required to become an athletic trainer.

She explained that she is concerned with the definition of “directing
physician” in the bill. She stated that with this definition, it would allow for a
referral process that an athletic trainer can refer to a directing physician and
a referring physician can make a referral to an athletic trainer under a
different referring physician. She further explained that she is concerned
with patient care and the need for clarification for these referrals.

EXCUSED:

She further explained that parents should be told of the risks of vaccines
before they are administered and felt that there should be a fine for those
who break the current immunization law.